Leprosy type 1 reaction as the first manifestation of borderline lepromatous leprosy in a young native German.
While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. Leprosy rarely presents with a reaction. We describe a German patient who presented in this unusual way in order to demonstrate the various tools used to confirm the diagnosis. A young German woman suddenly developed progressive functional loss of the left hand and within a few weeks an increasing number of erythematous macules and nodules appeared. Histological examination of a skin biopsy revealed tuberculoid granulomas, some located around small nerves; acid-fast bacilli were detected microscopically and DNA from Mycobacterium leprae was identified by polymerase chain reaction in the biopsy and a nasal swab; serological tests were positive. The disease was classified as borderline lepromatous leprosy. The acute neuritis followed by skin lesions represented a leprosy type 1 reaction in which the immune system reacts to bacilli previously unrecognized in nerve tissue, both in nerve and skin.
Biedermann
T
T
Department of Dermatology, Ludwig-Maximilians University, Munich, Germany.
Degitz
K
K
Schirren
C G
CG
Burgdorf
W
W
Plewig
G
G
Bieber
T
T
D000208:Acute Disease; D000328:Adult; D005260:Female; D006225:Hand / Q000294:innervation; D006801:Humans; D007918:Leprosy / Q000145:classification; D015440:Leprosy, Lepromatous / Q000150:complications / Q000473:pathology*; D009443:Neuritis / Q000209:etiology